Asthma management in school-aged children, particularly controller medication use, is best conceptualized as parent-child shared management. Controller medication nonadherence is common, and leads to higher disease morbidity such as cough, sleep disruption, poor activity tolerance, and asthma exacerbation. The purpose of this study was to describe asthma illness representations of both school-aged children (6-11 years) with persistent asthma and their parents, and to examine their interdependence. The Common Sense Model of Self-regulation, modified to include Parent-Child Shared Regulation, provided the framework for this descriptive, cross-sectional study. Thirty-four parent-child dyads independently reported on asthma control, controller medication adherence, and asthma illness representations by completing the Childhood Asthma Control Test, Medication Adherence Report Scale for Asthma, Brief Illness Perception Questionnaire, and Beliefs about Medicines Questionnaire. Using intraclass correlations, moderate agreement was evident between the parent and child timeline (perceived duration) illness representation domain (ICC= .41), and there was a weak association between the parent and child symptoms domain (ICC = .13). The remaining controllability and consequences domains showed no agreement. Hierarchical regression analyses were used to test parent and child illness representation domain variables as predictors of parent or child estimates of medication adherence. With parent-reported medication adherence as the dependent variable, regression models used parent illness representation variables followed by the corresponding child variable. Parent beliefs about medication necessity versus concerns was a significant predictor of parent-reported treatment adherence (β = .55, p < .01). Child-reported treatment control was also predictive of parent-reported treatment adherence (β -.50, p < .01). When child-reported medication adherence was the dependent variable, the child illness representation variable was entered first followed by the parent variable. Child beliefs about medication necessity versus concerns was the only significant predictor of child-reported adherence (child β .50, p < .01), none of the parent variables reached significance. Findings from this study indicate that although there are similarities between parent and child asthma illness representations, parental illness representations do not predict children's estimation of controller medication adherence. These findings indicate that school-aged children develop illness representations somewhat independent from their parents and, therefore, are critical participants in both asthma care as well as research.

Background Estimates of 1.6 million to 3.8 million concussions or mild traumatic brain injuries (mTBI) occur annually in adolescent athletes participating in contact sports (Daneshvar et al., 2011). Current clinical guidelines call for interventions to include education, assessment, screening, and long term management of injury by the adolescent's primary care provider (PCP) (Giza et al., 2013). Without proper knowledge of the injury's physiological process and progression, providers are possibly increasing the risk of continued brain injury in this population (Reddy & Collins, 2009). Purpose This doctorate of nursing practice project aimed to determine if a gap existed between provider knowledge about the current guidelines for management of mTBI in adolescent athletes of Arizona. Knowledge obtained from this survey could be further used to drive practice change. Methods A quantitative needs assessments study was conducted via data collection obtained through PCP's participation in an anonymous electronic survey using the survey software Qualtrics. Survey links were sent to potential participant's email addresses throughout Yuma County, AZ. An additional survey link was posted to the Arizona Nurses Association e-newsletter. The survey consists of 28 questions divided into three categories of demographics, knowledge, and practice questions. Outcomes Survey results were limited due to only 21 providers responding to the request for participation. From this sampling, it was determined that participant's clinical knowledge and practice related to screening, assessment, long term management, and continuity of care between the ED provider and follow up care with the primary provider were not congruent with current practice guidelines.

Survival status of 45 elderly skilled nursing care residents was examined over a 42 month period following involuntary interinstitutional relocation. Medical and relocation planning records provided data to examine survival status of residents in relation to focal and contextual stimuli. Results were compared to a relocation study previously conducted in the same community. Significant relationships existed between survival status and family support and participation in relocation planning event. A higher percentage of subjects survived who did not have family support and did not participate in planning events. A significant relationship was found between time intervals in which deaths of male and female subjects occurred. In the first nine months, 13 of 14 males died; six of the 14 females died. No significant relationships were found between survival status and age, gender, mobility, or dementia. Findings suggest the need for continued study of variables affecting survival status of relocated elders.

According to the United States Department of Health and Human Services (1999), between 10-15% of children and adolescents in the United States show some symptoms of depression that interfere with their functioning at home and school. This same report indicated that only 20-25% of these children get the treatment they need to cope with this significant debilitating condition. Adults often turn to spirituality in order to find comfort, hope and relief from distress. Spirituality refers to one's own beliefs, experiences and ideals concerning how to cope with a crisis (Elkins & Cavendish, 2004). However, most work in spirituality has been done with adults; little is known about the ways in which spirituality may be used or expressed by children who are facing difficulty in life, and especially among clinically children with depression (Elkins et al., 2004).The purpose of this study was to investigate experiences and views that promote well-being among school-age children (ages 9-12 years) who had been diagnosed with depression, and specifically what role spirituality has in this process. The goal was to better understand the process of how these children express and find purpose and meaning in their life in order to find a sense of hope, comfort and strength in order to cope during their experience with depression. The method used for this study was grounded theory, designed to examine an underlying social process (Glaser & Strauss, 1967). The sample consisted of 7 English speaking children ages 9-12 that had been diagnosed with depression not otherwise specified or dysthymia. Children were patients at a counseling center in Arizona. A semi-structured interview schedule ensured that the research questions were answered. Data were analyzed using constant comparison of themes across and within data from the participants and other text-based sources.Self-regulation, which included spiritually-related approaches, was found to be a key underlying process of coping in this group of children. Understanding the process of spiritual self-regulation was useful in providing more definitive knowledge for theory-guided practice with clinically depressed school-aged children.

This study explored the emerging Self-Imposed Activity Limitation (SIAL) theory among community dwelling elders. This theory was examined using the proposed Aging Well Conceptual model which was guided by Baltes' Selection, Optimization with Compensation model, Markus and Nurius' Envisioned Possible Selves theory, Kuypers and Bengtson's Social Breakdown Syndrome model, Bandura's Self-Efficacy theory, and Rotter's Locus of Control theory. The objectives of this study were to explore the relationships among multiple variables in a hierarchical model and to examine the explanatory power of the SIAL variables in predicting elders' well-being.A correlational descriptive design with a causal modeling approach was used employing Structural Equation Modeling (SEM) techniques. The Aging Well model was tested through a secondary analysis of the National Survey of Midlife Development in the United States (MIDUS) database selecting respondents aged 65-74 years.Two research questions guided this study. Research question one, how well does the Aging Well model fit with empirical sample data, was explored. The Aging Well model statistically approximated the MIDUS data after theoretical and statistical modifications and explained 76% of the variance of elder's well-being. The mediating effects of SIAL variables were determined by nested alternative model testing. Research question two, are the proposition statements in the Aging Well model valid, and was demonstrated empirically by the expected patterns of correlation and covariance among most of the variables in the Aging Well model.SIAL as a composite factor had a large positive effect on elder's well-being. Elders' perceived constraints and perception of aging had no direct effect on well-being. The influences of these two factors on well-being were mediated by a common factor, SIAL. These findings supported the emerging SIAL theory by suggesting that the optimal use of SIAL would lead to adaptive outcomes promoting elders' well-being. In addition, SIAL mediated the effects of elders' sense of control and perception of aging on well-being. The full range of SIAL could not be examined due to limitations inherent in secondary data analysis.

Background: Latinas experience a greater number of symptoms and are at an elevated risk for depression and anxiety following a diagnosis of breast cancer compared to Non-Hispanic Whites and African Americans. Cancer-related symptom clusters are frequently reported in women with breast cancer and research suggests these women follow distinct trajectories for depression and anxiety. However, little is known about the trajectories of anxiety and depression or cancer-related symptom clusters in Latinas with breast cancer. Methods: 296 Latinas previously recruited and diagnosed with breast cancer comprised this sample. Questionnaires for depression (the Center for Epidemiological Studies-Depression) and Anxiety (Speilberger State-Trait Inventory and PROMIS Anxiety) were administered at baseline, 2 and 4 months post enrollment. To identify classes of Latina breast cancer survivors based on patterns of symptom occurrence, symptoms latent class analysis was used to describe symptom clusters. Group-based growth mixture modeling was utilized to identify classes of women who followed distinct trajectories of depression and anxiety. Results: On average women reported 4.2±3 symptoms with an overall symptom distress score of 6.4±2.5 (out of a scale of 10). Three symptom classes were identified: Weary and Sleepy (class 1), Weary (class 2) and Weary, Sleepy and Hurting (class 3). Women were most likely to cluster in class 1, followed by class 2 and 3 with fatigue (labeled weary) being the most prevalent symptom for all three classes. Three trajectories emerged for both depression and anxiety. For depression, the majority of women (79.6%) fell in the high then reducing trajectory for depression followed by the low and remaining low (17%) and the high and increasing (worsening) trajectories of depression (3%). For anxiety the majority (78% of women) followed the moderate to increasing (worsening) trajectory of anxiety followed by 14% in the moderate to declining (improving) and 8% in the low to slightly increasing (worsening) trajectories for anxiety. Conclusion: This study suggests Latina breast cancer survivors experience burdensome cancer-related symptom clusters and distinct trajectories for depression and anxiety. Further research is needed in minority women with breast cancer to adequately understand and treat cancer-related symptom clusters as well as depression and anxiety.

Introduction: Pediatric obesity prevention and management is a high priority for pediatric providers. Pediatric providers use evidence-based clinical guidelines to integrate the best current recommendations into practice. The contention of this inquiry is that while practice guidelines and obesity programs address the "who, what, when, where, and why" of pediatric obesity interventions, the guidelines fail to address the "how" of the process that bolsters adherence and attacks the high attrition rates of obesity management. Objective: The objective of this practice inquiry is to evaluate Prevention and Treatment for Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion using the Appraisal for Guidelines and Research and Evaluation (AGREE II) instrument and to investigate techniques to improve adherence to the lifestyle changes recommended in the guideline, by synthesizing the current research for using motivational interviewing with obese pediatric patients, and propose a plan for translating the intervention to measurable outcomes. Methods: Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion was evaluated using the AGREE II instrument. The current recommendations are detailed based on the findings of a review of the literature. Using the RE-AIM framework, recommendations are made to determine the translation potential for the use of motivational interviewing to improve adherence to lifestyle recommendations, thus improving the current clinical practice guideline. Results: Review of the Endocrine Society's CPG using the AGREE II instrument yielded an overall guideline quality rating of 6/7. The guideline is recommended for use with modifications to improve applicability. Integration of MI to the practice guideline and the use of the RE-AIM framework to improve uptake of the intervention is proposed to address the weaknesses in applicability revealed in the guideline evaluation. Conclusion: The CPG reviewed in this PI provides quality recommendations for the treatment and prevention of pediatric obesity. By integrating MI techniques and using the RE-AIM framework, pediatric providers may be able to bolster adherence to the guideline recommendations and ultimately improve clinical outcomes and impede the rising pediatric obesity rates. Future research should include evaluation of MI interventions in the pediatric clinical setting.

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